Work 71 (2022) 851–858 851

DOI:10.3233/WOR-211099
IOS Press

Safe practices of biomedical and dental

waste management amongst practicing
dental professionals amid the COVID-19
pandemic
Quratulain Mariama , Naseer Ahmeda,b , Maria S. Abbasia , Resham Nadeema , Asma Rizwana ,
Fahim Vohrac,∗ , Tariq Abduljabbarc and Adel Abduljabbard
a Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi, Pakistan
b Schoolof Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
c Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
d Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia

Received 14 August 2021

Accepted 12 November 2021

Abstract.
BACKGROUND: Biomedical waste can potentially compromise the environment and public safety if not safely disposed.
OBJECTIVE: The aim was to assess the understanding and safe practices of biomedical and dental waste amongst the dental
practitioners and practical year students amid the COVID-19 pandemic.
METHODS: A structured and validated questionnaire consisting of 21 closed ended questions was used to collect data from
dental practitioners and students working in hospitals and clinics. The questionnaire was distributed in paper and digital form
amongst the participants. Descriptive analysis was performed for categorical and numerical variables. Spearman correlation
test was used to assess the relationship between awareness and waste disposal practices of dentists. A p-value of ≤ 0.05 was
considered as statistically significant.
RESULTS: More than three fourth of the participants were aware of proper dental waste disposal steps. One half was
aware of the color-coded segregation of biomedical waste management. Two third of the participants were deploying safe
biomedical waste practices. Nearly 68% subjects allocated separate labeled containers for disposal of COVID-19 suspected
patient’s waste. Furthermore, 71.63% participants were practicing PCR test before aerosol procedures. While 88.65% partic-
ipants believed that the COVID-19 pandemic has increased the financial burden in terms of safe practices and dental waste
management.
CONCLUSION: The awareness and practices of the participants towards dental waste management was found to be moderate.
Satisfactory COVID-19 prevention and transmission measures were observed amongst the participants. BMW management
lessons should be included in the academic curriculum and training program needs to be adopted for mass awareness.

Keywords: Biomedical waste, dental waste, dental care professionals, practical year students, COVID-19

∗ Address for correspondence: Fahim Vohra, Professor, Depart-
ment of Prosthetic Dental Science, College of Dentistry, King
Saud University, Riyadh 11545, Saudi Arabia. E-mail: fvohra@
ksu.edu.sa.
1. Introduction
Coronavirus disease-2019 (COVID-19) has
affected more than 80 million people and have
caused more than 1.8 million deaths worldwide as

ISSN 1051-9815/$35.00 © 2022 – IOS Press. All rights reserved.

852 Q. Mariam et al. / Safe practices of biomedical and dental waste management
of December 2020. The disease has a wide range
of symptoms reported including, fever, cough,
shortness of breath, headache, nausea, vomiting,
diarrhea and loss of smell or taste. Older people or
who have severe underlying medical conditions like
heart or lung disease, or diabetes seem to be at higher
risk for developing more serious complications from
COVID-19. Over a period of time vaccines were
developed that continue to reduce a person’s risk of
contracting the virus. But it is not known yet that how
effective the vaccines will be against the new variants
that may arise. In addition to severely compromising
the health of people around the globe it has also left
a lasting impact on the economies and healthcare
infrastructures globally. Dental services like all other
health services were forced to adopt immediate
restrictions for all kind of oral procedures except
for the emergency treatments [1–3]. As the situation
improved, dental clinics resumed services and oral
health care professionals are providing partial or
full range of services depending on the spread of
COVID-19 hotspots around the globe [4, 5].
Dental office is a vulnerable site for infection and
spread of COVID-19 due to aerosol generation and
close individual contact. Therefore, dental practition-
ers need to adopt standard procedures, not only to
curb the transmission of COVID-19, but also to dis-
pose the infectious waste in a manner to avoid cross
contamination. As dental services are returning back
to pre-pandemic practices, it is highly critical that
dental practice be modified to prevent cross infection
of COVID-19, not just in the clinical setting but also
by other means including waste management [4–7].
The rising need of dental care in the recent times
has also increased the demand for new dental clin-
ics, ultimately increasing the amount of biomedical
and dental waste [8]. Biomedical waste became a
topic of interest back in the 1990s, when Human
Immunodeficiency Virus (HIV) and Hepatitis B virus
(HBV) became life threatening [9]. Biomedical waste
(BMW) is produced during diagnosis, treatment or
immunization of humans and animals in hospitals,
research institutions, health care teaching institutes,
clinics, laboratories, blood banks, animal houses,
and veterinary institutes [10]. Waste management is
the key for human health as well as for a healthy
environment [8]. Inappropriate waste disposal and
management can be a risk to healthcare workers,
general public as well as the waste handlers, as con-
taminated waste if improperly managed, may cause
health risks and physical injury. In addition, there
may be greater risk of nosocomial infections and
antibiotic resistance in the event of improper waste
management [10].
Dental waste includes the materials that have been
used in the dental clinic and then discarded includ-
ing cotton, latex, sharps, plastic, extracted teeth, lead
foil and mercury from amalgam restorations. Dental
waste can potentially compromise the environment
and public safety if not properly and safely disposed
[11]. Alarmingly, majority of the biomedical and den-
tal waste produced is either dumped, incinerated in
landfills or left untreated in a water body [12]. Usu-
ally, failure to dispose of used syringes and blades
properly, increases the chance of reuse and transmis-
sion of diseases [13]. The first step towards effective
biomedical waste management is the identification
and segregation of the waste generated. Accord-
ing to the current guidelines for waste segregation,
following colour coding is recommended: yellow
container for infectious, pathological and anatomi-
cal waste marked “Highly infectious”; yellow plastic
bag for sharps, that should be leak and puncture-proof
marked “sharp”; brown plastic bag for chemical and
pharmaceutical waste; radioactive waste in a lead box
marked with a radiation symbol and black plastic bag
for general healthcare waste [14].
There are usually two ways to dispose the biomed-
ical waste (BMW) produced by the dental clinics i.e.,
landfills and incineration [12]. When landfills are not
created carefully, it can contaminate drinking water;
and incineration itself can emit harmful fumes and
ashes. The waste management remains a major chal-
lenge in many countries including Pakistan as there is
no conventional place for the disposal [14]. It is there-
fore important for all healthcare workers including
dental care providers to have sufficient understanding
regarding dental waste management, its segrega-
tion, treatment, storage, transportation and disposal
[15–17]. The data on safe practices of biomedical
waste is limited and the present study will pro-
vide baseline information for assessing future risks
from improper waste management in pandemics. The
present study thus aims to assess the understanding
and safe practices of biomedical and dental waste
amongst the dental practitioners and also provides
an insight on the method of disposing infected/used
needles in relation to the type of practice of the prac-
titioners.
2. Material and methods
This cross-sectional study was conducted at dental
hospitals and clinics, over a period of 5 months i.e.,
 Q. Mariam et al. / Safe practices of biomedical and dental waste management 853

from September 2020 to January 2021. The sample

size was calculated with OpenEpi software. Consid-
ering the mean knowledge and behaviour score of
dentists (3.7 ± 1.3), at 80% power and confidence
interval of 95%, the estimated sample size was 505
participants [17]. The sample size was overestimated
to 564 participants for maximum participation. A
non-probability convenience sampling technique was
applied to recruit participants. A self-administered
structured questionnaire was used to collect the
data (Appendix). Section one of the questionnaire
focussed on assessment of the understanding about
biomedical and dental waste and its management,
using 12 close ended questions. The questions
included, guidelines laid down by government, con-
sequences without proper BMW management, BMW
rules, categories and colour coded waste segregation.
Section two assessed practices with six closed ended
questions; including, BMW inclusion into the cur-
riculum, use of PPE’s, method of disposal used in
self-practice, items on COVID-19 patient waste dis-
posal and emphases on the polymerase chain reaction
(PCR) test to detect COVID-19 patients. The internal
consistencies of questionnaire items were assessed
through Cronbach’s alpha (␣ = 0.70). The flow dia-
gram depicting standard BMW waste management is
shown in Fig. 1.
The data were collected through distributing copies
of the questionnaire as well as digital files using
Google forms. The link of digital questionnaires was
created and shared with the dental practitioners who
could not be approached in person. The sample size
for participants was 600 practicing dentists at private
clinics and government dental hospitals including
undergraduate students. Fig. 1. Steps of biomedical waste management.
The data were analysed using Statistical pro-
gram for social sciences (SPSS- version 25, IBM,
NY, USA). Descriptive analysis was performed to were graduates, and 117 postgraduates. Both public
analyse mean, standard deviation and frequency of and private sector dentist were included; 441 partici-
categorical and continuous variables. Spearman cor- pants were from private sector while 123 were from
relation was applied to identify relationship between public sector (Table 1).
awareness and practices of BMW amongst dental Table 2 shows that 208(36.9%) participants
practitioners. A p-value of ≤ 0.05 was considered believed that guidelines have been laid down by the
significant. government for BMW management, whereas 469
participants (83.2%) believed that an ongoing coor-
dination between governmental bodies, institutes and
3. Results health personnel will lead to proper BMW man-
agement. 477 (84.6%) participants agreed that there
Five hundred and sixty four (564) participants’ are consequences and health hazards without proper
submitted complete responses. 161 (28.5%) were biomedical waste management, while 58.9% partic-
males and 403 were (71.5%) females. Two hundred ipants were aware of the different biomedical and
and forty three were undergraduate students, 204 dental waste categories.
854 Q. Mariam et al. / Safe practices of biomedical and dental waste management

Table 1 disposing used radiographic films, metals and gloves,

Demographics characteristics of participants (n = 564) 37.6% were unaware, 15.6% preferred black, 13.5%
Variables N % selected red, 13.1% chose green, 11.9% selected
Gender yellow while 8.3% opted for blue (Table 4). Regard-
Male 161 28.5 ing the color-coded bag used for disposing off used
Female 403 71.5
Educational qualification sharps and needles, 52.5% said red while, 25.2%
Undergraduate 243 43.1 were unaware. Other selections included 9.8%, 7.1%,
Graduate 204 36.2 4.6% and 0.9% of yellow, black, blue and green
Postgraduate 117 20.7
respectively. Regarding the color of bag used for dis-
Sector
Private 441 78.2 posing extracted teeth and/or human tissues, 35.1%
Public 123 21.8 did not know, 29.3% selected red, 14.2% preferred
Practice yellow, 9.4% opted black, 8% chose blue and 4.1%
General dental clinics 144 25.5
Training positions 394 69.9
selected green. However, when the understanding
Both 26 4.6 regarding the color of bag for mercury or scrap of
N: Frequency, %: percentage. silver amalgam was assessed, 47.2% did not know.
However, 23.9%, 9.2%, 8.3%, 6.4% and 5% par-
ticipants selected black, yellow, green, red and blue
When asked about the first step for BMW manage- colors respectively.
ment, 331 (58.7%) believed that it was segregation. Table 5 presents the safe practices of biomedical
However, 151 (26.8%) participants thought it was and dental waste amongst the participants. 94.3%
disposal, 49 (8.7%) opted for storage, 22 (3-0.9%) believed that there is a need of including educational
said treatment and 11 (2.0%) believed it to be trans- program for BMW management in the academic cur-
port. Regarding biomedical and dental waste storage riculum, whereas 3.9% said no and 1.8% did not
duration, 191 participants (33.9%) said that it should know. 92.4% of participants believed that waste han-
not be stored beyond 48 hours, 157 (27.8%) said dlers should use personal protective equipment, 2.8%
that waste should not be stored beyond 12 hours, 37 said no while 4.8% did not know. Regarding practic-
(6.6%) opted for 72 hours. 179 (31.7%) subjects did ing segregation of different types of waste, 56.4%
not know the storage duration for BMW (Table 3). participants agreed, 30.1% said no, while 13.5%
Regarding color-coded segregation of BMW, did not know. 58.7% participants did not dispose of
57.4% believed that they knew color coding of biomedical and dental waste themselves at their prac-
BMW (Table 2). However on assessment, 37.2% tice, while 34.8% agreed and 6.6% were unaware.
of the participants did not know about the color 77.4% believed that sharp cutters should be used to
coded bag used for disposing off used impression cut all syringes and blades, 14.5% did not agree and
materials, expired dental materials and discarded 8.1% were unaware. 72.2% (407) participants dis-
medicines, 17% said these are disposed off in black, posed infected needles by breaking in sharp container,
15.2% said yellow, 9.6% said blue, 13.7% said green while 16.8% (95) broke needles and disposed them
while 7.3% said red. Regarding the color of bag for in common bin. 380 (67.37%) participants confirmed

Table 2
Distribution of biomedical and dental waste awareness level and its management amongst participants (n = 564)
Variables Yes No Do not know
N % N % N %
Guidelines laid down by the government for 208 36.9 91 16.1 265 47.0
BMW management?
Coordination between governmental bodies, 469 83.2 40 7.1 55 9.8
institutions and health personnel will lead to
proper BMW management?
Consequences/ health hazards without proper 477 84.6 44 7.8 43 7.6
biomedical waste management?
Aware of different categories of biomedical and 332 58.9 140 24.8 92 16.3
dental waste?
Knowledge about the color coded segregation of 324 57.4 101 17.9 139 24.6
BMW?
N: Frequency, %: percentage; BMW: Biomedical waste.
 Q. Mariam et al. / Safe practices of biomedical and dental waste management 855

Table 3
Distribution of biomedical and dental waste awareness level and its management amongst participants (n = 564)
Variables N % N % N % N % N %
Storage Segregation Treatment Transportation Disposal
The first step for BMW management? 49 8.7 331 58.7 22 3.9 11 2.0 151 26.8
Waste should not be stored beyond 12 hrs 48 hrs 72 hrs 96 hrs Do not know
a time period of?
157 27.8 191 33.9 37 6.6 179 31.7 179 31.7
N: Frequency, %: Percentage, hrs: Hours.

Table 4
Distribution of awareness level of biomedical and dental waste disposal (n = 564)
Red Black Yellow Blue Green Do not know
N % N % N % N % N % N %
Bag for used impression materials, expired dental 41 7.3 96 17.0 86 15.2 54 9.6 77 13.7 210 37.2
materials and discarded medicines
Bag for used radiographic films, metals and gloves 76 13.5 88 15.6 67 11.9 47 8.3 74 13.1 212 37.6
Bag for used sharps and needles 296 52.5 40 7.1 55 9.8 26 4.6 5 0.9 142 25.2
Bag for extracted teeth and/or human tissues 165 29.3 53 9.4 80 14.2 45 8.0 23 4.1 198 35.1
Bag for mercury or scrap of silver amalgam? 36 6.4 135 23.9 52 9.2 28 5.0 47 8.3 266 47.2
N: Frequency, %: percentage.

Table 5
Distribution of safe practices amongst participants (n = 564)
Variables Yes No Do not know
N % N % N %
Need of including educational program for BMW 532 94.3 22 3.9 10 1.8
management in the curriculum?
Waste handlers should use personal protective equipment? 521 92.4 16 2.8 27 4.8
Different types of waste segregated at practice? 318 56.4 170 30.1 76 13.5
Disposing biomedical and dental waste yourself? 196 34.8 331 58.7 37 6.6
Sharp cutters should be used to cut all syringes and blades? 454 80.5 454 80.5 43 7.6
Are there separately labelled bins and container for the 380 67.37 120 21.27 64 11.34
suspected COVID-19 patient waste in your practice?
Are you prescribing nasal swab PCR to your patient prior 404 71.63 100 17.73 60 10.63
aerosol generated procedures?
Has the COVID-19 pandemic increased financial burden on 500 88.65 40 7.09 26 4.60
biomedical n dental waste management?
N: Frequency, %: percentage.

Table 6
Relationship between the type of practice and method of disposing infected needles (n = 564)
Variables Dispose in Break needle and Break needle and dispose Correlation␣ P value␤
Common bin dispose in common bin in sharps container
General dental clinics 20 3.54 15 2.65 109 19.32 – 0.03 0.37
Training positions 39 6.91 74 13.12 281 49.82
Both 3 0.53 6 1.06 17 3.01
␣ Spearman correlation test; ␤ level of significance was set at p ≤ 0.05.

the use of separately labeled bins and container for
the suspected COVID-19 patients and cross contam-
ination prevention. To curtail the spread of SARS
CoV-2; nasal swab and PCR test was practiced by
404 (71.63%) participants. 500 (88.65%) participants
reported that due to the COVID-19 pandemic the
financial burden has increased. Forty (7.09%) par-
ticipants reported no financial burden so far at their
dental practice.
Table 6, presents the relationship between the type
of practice and the method of disposal of infected
needles. Among the three fourth participants work-
ing in training positions, 281 (49.82%) broke needles
and disposed them in designated sharp containers, 74
(13.12%) disposed needles in common dust bin after
breaking, while 39 (6.91%) disposed them in com-
mon bins without breaking. Furthermore, among the
one participants working in general dental clinics,
856 Q. Mariam et al. / Safe practices of biomedical and dental waste management
109 (19.32%) broke needles and disposed them in a
sharp container, 15 (2.65%) disposed it in a common
container and 20 (3.54%) participants disposed nee-
dles in a common bin without breaking. There was no
significant relation (p = 0.37) between type of prac-
tices and awareness of dental waste disposal amongst
the participants.
4. Discussion
Adequate biomedical waste (BMW) disposal is
one of the neglected aspects of health care for years
especially in developing countries. The situation got
worst due to the excessive use of PPEs, including
gloves, masks, gowns and other protective equip-
ment amidst COVID-19. According to a study by
Jalal et al, healthcare practitioners (HCPs) of some
countries lack adequate knowledge regarding BMW;
they dispose the wastes in litterbins along with other
general household waste instead of considering the
use of specific color coded bags for disposal. This
might increase the chances of infection and transmis-
sion especially in the current COVID-19 pandemic
[18, 19]. Additionally, HCPs are expected to have
sufficient knowledge regarding BMW since it is esti-
mated that 10–25% of it is infectious [20]. Therefore,
the present study was performed to evaluate the
understanding and practices of dental professionals
in relation to dental waste management.
Biomedical and dental waste (BMDW) is an
emerging issue and therefore requires active involve-
ment and harmonization between the government,
medical vicinities and all healthcare personnel. How-
ever in the present study, only 36.9% of respondents
believed that there are certain guidelines provided by
the government for BMW management; majority i.e.
47% did not even know if there were any guidelines
laid down by the government to be followed. This
may be due to the fact that 43.1% of respondents
were undergraduates and had limited knowledge in
this regard. This is similar to a study by Singh et al,
where less than 50% of the students were aware about
the guidelines laid down by government of Nepal
for BMW management [21]. In addition, 83.2% of
the respondents in our study believed that a strong
coordination between governmental bodies and insti-
tutions might help in proper waste management.
Literature suggests that in addition to the policies
given, the knowledge regarding dental waste manage-
ment should be continuously updated and monitored
by the authorized bodies. It is reported previously,
that 94.3% of the respondents believe in the need
of inclusion of educational program regarding BMW
management in the curriculum [22, 23]. Further-
more, majority of the respondents of the present study
(84.6%) were aware of the consequences/health haz-
ards associated with improper waste management;
however, 58.9% were aware of different categories
of biomedical and dental waste. This is critical as
inadequate knowledge of handling waste may result
in environmental degradation and can harm the com-
munity especially during a pandemic [24].
Moreover, as literature proves that waste segre-
gation is a vital step of waste management and
color-coding helps in taking the waste to different
sites for disposal, therefore putting wrong waste in a
designated container would invalidate the efforts of
appropriate waste disposal [25]. Although 58.7% of
the respondents in this study correctly answered that
segregation should be the first step of BMW manage-
ment, however, 57.4% of the respondents believed
that they knew about different color-coding for the
biomedical waste. However, only 4.6% of the respon-
dents in the present study knew the correct color code,
showing lack of color-coding application amongst the
dental professionals. However similar findings were
also reported in previous studies [26].
The management of dental waste is of utmost
importance in the pandemic due to risk of cross
contamination. In the present study to prevent
contamination, 67.37% participants used separately
labelled bins for disposing off suspected COVID-
19 patient’s waste. Dental waste from suspected and
confirmed COVID-19 patients was considered as
infectious medical waste and should be stored in a
tight knot, double layered, yellow clinical bag. The
surface of respected bag should be labelled and dis-
posed as medical waste [27]. It was also found that
participants were making sure to treat patients free
of COVID-19, when aerosol generated procedures
were performed, as a prior nasal swab and PCR test
was ordered by 71.63% of participants for patients.
COVID-19 testing should be required for suspected
cases with or without COVID-19 symptoms in order
to prevent transfer of infections in the community
[28].
Furthermore, sharp instruments such as needles
and syringes are the most common hazardous waste in
dental practice. The nature of dental practice in terms
of waste management was assessed in this study and it
was found that majority of the respondents, (72.16%)
is following safe practices as they break the needle
and dispose it off in sharps container. These findings
 Q. Mariam et al. / Safe practices of biomedical and dental waste management
are similar to the study by Naidu et al, where 65.5%
of the dentists practiced the recommended needle
disposal protocol [29]. 56.4% of the dentists in the
present study agreed to practice waste segregation.
These numbers are very low, compared to a previous
study by Reddy et al., which showed 99.2% of den-
tists to be segregating dental waste [30]. Therefore,
despite the awareness among dental practitioners,
training and surveillance is required to ensure waste
segregation and management practices.
The present study highlights the critical problems,
which can be avoided by safe BMW manage-
ment practices, however a causal relationship of the
awareness to the environmental hazards, specifically
COVID-19 infections was not assessed. Therefore it
is critical to correlate infection rates with BMDW
management practices, in future studies. Moreover,
it is suggested that the governing bodies should
revise the guidelines and policies by keeping COVID-
19 into consideration and should strictly implement
them. Furthermore, training programs and regular
refresher sessions should be organized on recom-
mended BMW management protocols, including the
segregation and color coding of the waste for the doc-
tors, nurses, technicians and other staff members of
dental hospital and clinics.
5. Conclusion
The awareness and practices of the participants
towards dental waste management was found to be
moderate. Satisfactory COVID-19 prevention and
transmission measures were observed amongst the
participants. BMW management lessons should be
included in the academic curriculum and training
program needs to be adopted for mass awareness.
Acknowledgments
The authors are grateful to the Researchers sup-
porting project at King Saud University for funding
through Researchers supporting project No. (RSP-
2020-240).
Author contributions
NA and MSA: Data interpretation, manuscript
writing, final and critical approval. FV and
857
TA: Manuscript drafting, literature review, final
manuscript approval. AA and QM: Concept and study
design, data collection, literature review, manuscript
writing. RN: Data acquisition, data interpretation, lit-
erature review. AR: Data collection, writing, revise,
editing.
Supplementary materials
The appendix is available from https://dx.doi.org/
10.3233/WOR-211099.
Conflict of interest
The authors declare no conflict of interest.
References
[1] So MKP, Chu AMY, Tiwari A, et al. On topological
properties of COVID-19: predicting and assessing pan-
demic risk with network statistics. Sci Rep. 2021;11:5112.
https://doi.org/10.1038/s41598-021-84094-z
[2] Abbasi MS, Ahmed N, Sajjad B, Alshahrani A, Saeed S, Sar-
faraz S, Alhamdan RS, Vohra F, Abduljabbar T. E-Learning
perception and satisfaction among health sciences students
amid the COVID-19 pandemic. Work. 2020;67:549-56.
[3] Dargahi A, Jeddi F, Ghobadi H, Vosoughi M, Karami
C, Sarailoo M, Hadisi A, Mokhtari SA, Haghighi SB,
Sadeghi H, Alighadri M. Evaluation of masks’ internal
and external surfaces used by health care workers and
patients in coronavirus-2 (SARS-CoV-2) wards. Environ
Res. 2021;196:110948. doi: 10.1016/j.envres.2021.110948.
[4] Ahmed MA, Jouhar R, Ahmed N, Adnan S, Aftab M, Zafar
MS, Khurshid Z. Fear and practice modifications among
dentists to combat novel coronavirus disease (COVID-19)
outbreak. International Journal of Environmental Research
and Public Health. 2020;17(8):2821.
[5] Ahmed N, Shakoor M, Vohra F, Abduljabbar T, Mariam
Q, Rehman MA. Knowledge, awareness and practice of
health care professionals amid SARS-CoV-2, corona virus
disease outbreak. Pakistan Journal of Medical Sciences.
2020;36(COVID19-S4):S49.
[6] Dargahi A, Jeddi F, Vosoughi M, Karami C, Hadisi A,
Ahamad Mokhtari S, Ghobadi H, Alighadri M, Haghighi
SB, Sadeghi H. Investigation of SARS CoV-2 virus in
environmental surface. Environ Res. 2021;195:110765. doi:
10.1016/j.envres.2021.110765.
[7] Sarailoo M, Matin S, Vosoughi M, Dargahi A, Gholizadeh
H, Damavandi MR, Abbasi-Ghahramanloo A, Kam-
ran A. Investigating the relationship between occupa-
tion and SARS-CoV2. Work. 2021;68(1):27-32. doi:
10.3233/WOR-205066.
[8] Singh RD, Jurel SK, Tripathi S, Agrawal KK, Kumari R.
Mercury and other biomedical waste management prac-
tices among dental practitioners in India. BioMed Research
International. 2014;2014.
858 Q. Mariam et al. / Safe practices of biomedical and dental waste management
[9] Awasthi PK, Kumar G, Sinha A. Biomedical Waste Manage-
ment: An Approach To Reduce Environmental Pollution. Int
J Innov Res Adv Stud. 2018;5(2):1235.
[10] Hegde V, Kulkarni RD, Ajantha GS. Biomedical waste
management. Journal of Oral and Maxillofacial Pathology.
2007;11(1):5.
[11] Singh AK, Humagain M, Khanal N. Recommendations
based on International Guidelines for Safe Dental Practice
During Covid-19. Journal of Nepalese Society of Periodon-
tology and Oral Implantology. 2020,28;4(1):22-30.
[12] Abhishek KN, Supreetha S, Varma Penumatsa N, Sam
G, Khanapure SC, Sivarajan S. Awareness-knowledge and
practices of dental waste management among private prac-
titioners. Kathmandu Univ Med J. 2016;14(53):17-21.
[13] Ranjan R, Pathak R, Singh DK, Jalaluddin M, Kore SA,
Kore AR. Awareness about biomedical waste management
and knowledge of effective recycling of dental materials
among dental students. Journal of International Society of
Preventive & Community Dentistry. 2016;6(5):474.
[14] Arshad N, Nayyar S, Amin F, Mahmood KT. Hospital waste
disposal: A review article. Journal of Pharmaceutical Sci-
ences and Research. 2011;3(8):1412.
[15] Naz S, Naqvi SM, Jafry SI, Asim S. Knowledge, attitude
and practice regarding management of health care waste
among private dental practitioners. JPMA. The Journal of
the Pakistan Medical Association. 2020;70(7):1259-62.
[16] Sibanda LK, Obange N, Awuor FO. Challenges of solid
waste management in Kisumu, Kenya. InUrban Forum.
2017;28(4):387-402.
[17] Sabbahi DA, El-Naggar HM, Zahran MH. Management of
Dental Waste in Dental Offices and Clinics in Jeddah, Saudi
Arabia. Journal of the Air & Waste Management Associa-
tion. 2020;12(3):30.
[18] Jalal SM, Akhter F, Abdelhafez AI, Alrajeh AM. Assess-
ment of Knowledge, Practice and Attitude about Biomedical
Waste Management among Healthcare Professionals during
COVID-19 Crises in Al-Ahsa. Healthcare. 2021;9(6):747.
https://doi.org/10.3390/healthcare9060747
[19] Vosoughi M, Karami C, Dargahi A, et al. Investiga-
tion of SARS-CoV-2 in hospital indoor air of COVID-19
patients’ ward with impinger method. Environ Sci Pol-
lut Res. 2021;28:50480-8. https://doi.org/10.1007/s11356-
021-14260-3
[20] Mehta TK, Shah PD, Tiwari KD. A knowledge, attitude
and practice study of biomedical waste management and
bio-safety among healthcare workers in a tertiary care gov-
ernment hospital in Western India. Natl J Community Med.
2018;9:327-33.
[21] Singh T, Ghimire TR, Agrawal SK. Awareness of biomed-
ical waste management in dental students in different
dental colleges in Nepal. BioMed Research International.
2018;9;2018.
[22] GV U DG, Basu M. Assessment of knowledge, attitude and
practices of dental waste management among undergraduate
dental students of Bapuji Dental College and Hospital in
Davangere City-a cross sectional survey. Unique J Med Dent
Sci. 2016;4:8-13.
[23] Indhulekha V, Ganapathy D, Jain AR. Knowledge and
awareness on biomedical waste management among stu-
dents of four dental colleges in Chennai, India. Drug
Invention Today. 2018;10(12):32-41.
[24] Pawar PA, Patil TS. Knowledge, practice and attitude of
dental care waste management among private dental practi-
tioners in Latur city. International Dental Journal of Students
Research. 2017;5:80-4.
[25] Sudeep CB, Joseph J, Chaitra T, Joselin J, Nithin P, Jose
J. KAP study to assess biomedical waste management in
a dental college in south India. World J Pharm Pharm Sci.
2017;6:1788-94.
[26] Al-Oufi L, Saker S. Knowledge and Practice of Dental Waste
Management among Undergraduate Dental Students and
Interns in College of Dentistry, Taibah University, Saudi
Arabia. Journal of Advances in Medicine and Medical
Research. 2018;30:1-7.
[27] Fini MB. What dentists need to know about COVID-19.
Oral oncology. 2020;28:104741.
[28] Giudice A, Antonelli A, Bennardo F. To test or not to
test? An opportunity to restart dentistry sustainably in
the ‘COVID-19 era’. International Endodontic Journal.
2020;53(7):1020-1.
[29] Naidu SG, Reddy VC, Kumar RV, Sudhir KM, Sriniva-
sulu G, Athuluru D. Dental health-care waste management
among dentists of Nellore City-A cross-sectional study.
Journal of Indian Association of Public Health Dentistry.
2019;17(2):136.
[30] Karami C, Dargahi A, Vosoughi M, et al. SARS-CoV-2 in
municipal wastewater treatment plant, collection network,
and hospital wastewater. Environ Sci Pollut Res (2021).
https://doi.org/10.1007/s11356-021-15374-4